HomeMy WebLinkAbout0188 ELLIOTT ROAD - HAZMAT S' �L�xoTT J2oet.d
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TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION
MAP NO. ; ;V PARCEL NO. jq 07
ADDRESS OF TANK• o VILLAGE:
! (� / �..��.-/�/ �C.l.J
Numb.0rr at.r�wQ
MAILING ADDRESS `( IF(�DIFFF'EERRENT FFR/OEM ABOVE) : Wo
OWNER NAME: I�/�l l /Ii� r ��'1 /'+� PHONE: f ,
17
INSTALLATION DATE: 'Vi o BY:
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INSTALLER ADDRESS: CERT.NO.
*TANK LOCATION:
(0K00R I at TANK LOCAT I ON W I TM MKSPK.CT TO BU I V
CAPACITY TYPE OF TANK S 2�_� AGE /YM YRS. FUEL/CHEM I CAL / �..-
0A,
TESTING CERTIFICATION C I PASS C I FAIL DATE
LEAK DETECTION C ] CHECK IF N/A TYPE/BRAND !/�
ZONE OF CONTR I BUT'I ON C ] YES C ] NO DATE TO BE REMOVED �///.�
FIRE DEPT. PERMIT ISSUED C ] YES C ) NO DATE
CONSERVATION C ] CHECK IF N/A DATE / Q
BOARD OF HEALTH TAG NO. C ) � ]- DATE /)
C V9
# PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD